BOTOX^® Cosmetic Therapy

Introduction - 2008 Most Popular Cosmetic Treatment

We are proud to have been one of the earliest users of BOTOX^® Cosmetic with experience going back to 1996. BOTOX^® Cosmetic injections can rid your face of crow's feet, forehead lines, or frown lines. This has become our most popular cosmetic procedure because it is safe and patients love the results. BOTOX^® Cosmetic is a powerful medicine used to treat facial expression lines and neck banding as well as down-turned smiles and drooping eyes. Best of all, the procedure takes just a minute.

What Is BOTOX^® Cosmetic?

Botulism is food poisoning produced by a bacteria. BOTOX^® Cosmetic is a medicine produced by the same bacteria. BOTOX^® Cosmetic is not alive but is a protein that weakens and inactivates muscles. This is another example where natural products are used for medicinal purposes: fungi produce penicillin, cowpox virus protects against smallpox, foxglove plant produces the "poison" digitalis that millions of patients take daily for heart disease. Now with bioengineering it is common for bacteria to produce the necessary medicine for a specific disease.

First Clinical Uses Of BOTOX^® Cosmetic
 

In 1973, BOTOX^® Cosmetic was used as a treatment for patients with crossed eyes. By weakening the overactive eye muscles, this medicine provided an alternative to surgery. After this "breakthrough," BOTOX^® Cosmetic quickly gained acceptance for other ophthalmologic disorders including nystagmus and blephospasm (involuntary spasm of the eyelids) to name a few. Extensive BOTOX^® Cosmetic research confirmed repeatedly a high success rate with minimal side effects using minuscule amounts of this new found "medicine."

Safety
 

While BOTOX^® Cosmetic is potent medicine in high concentration, it is used in very small quantities with high margins of safety. After a muscle is injected, its first effects are not seen for 24 hours and the complete effect on the muscle will not be complete for two weeks. Fifty units (one half vial) or less of BOTOX^® Cosmetic per session is generally used. To have toxic effects on a patient, over 2,000 units would have to be injected at one time. BOTOX^® Cosmetic effects are attracted only to muscles, and it has no effect on the central nervous system or on the body if injected accidentally into a nerve or blood vessel. BOTOX^® Cosmetic is also safe because complete recovery of the muscle is possible. Recovery is due to the body's excellent ability to form new fibers that allow activation of the muscles.

Other Specialties Use BOTOX^® Cosmetic For Their Patients
 

Gastroenterology and neurology have explored BOTOX^® Cosmetic therapy for their patients. It has now become the mainstay of non-surgical therapy for spasmodic neck muscles, spasmodic laryngeal muscles, writer's cramp, certain tremors, tics, multiple sclerosis, cerebral palsy, post stroke states, spinal cord injuries, nerve palsies, Parkinson's disease, and facial spasms. BOTOX^® Cosmetic is used in GI cases involving swallowing and ulcer problems and to treat speech problems including stuttering. Also, treating genitourinary disorders of spastic bladder and other disorders with BOTOX^® Cosmetic has been studied. Congenital muscular disorders or acquired nerve injuries have been greatly improved with BOTOX^® Cosmetic.

Background Of The Cosmetic Use Of BOTOX^® Cosmetic
 

Cosmetic BOTOX^® Cosmetic injections were pioneered in 1988 by a Vancouver ophthalmologist and her husband, a dermatologist. Since that time, this team of doctors has performed over 10,000 sessions on its patients. The ophthalmologist noted that the wrinkles disappeared in her patients with eyelid spasms who were treated with BOTOX^® Cosmetic. This led to further research, which confirmed the effectiveness and safety of the BOTOX^® Cosmetic vaccine for improving wrinkles due to overactive muscles of the face.

In 1996 at the annual meeting of The American Academy of Dermatology in Washington, a presentation by dermatologist Dr. Nicholas Lowe showed that BOTOX^® Cosmetic was useful for improving facial expression lines. Significant improvement was noted on both forehead frown lines and crow's-feet. No significant side effects were noted beyond the expected injection discomfort. For 30 patients only 1 experienced a mild drooping of the upper eyelid, which cleared spontaneously. The length of effective improvement for the forehead frown lines was approximately 18 weeks. The degree of improvement of the crow's-feet was generally less than the forehead frown lines. BOTOX^® Cosmetic is not 100% effective in all patients.

BOTOX^® Cosmetic For Crow's-Feet and Frown Lines

   Before         After                                                           Before            After

Wrinkles radiating from the corner of the eyes caused by smiling, laughing, or squinting are especially distressing to some individuals. Previously, no reasonable medical or surgical solution improved this problem due to the strong underlying muscles. Even with the deepest chemical peels or laser resurfacing techniques, rapid recurrence of these lines around the eyes is inevitable. Now for best results, BOTOX® Cosmetic injections are used in conjunction with resurfacing procedures. It is the function of BOTOX^® Cosmetic to prevent the recurrence of wrinkles by inhibiting the underlying muscles.

Nasolabial Folds
 

This area is not ideal for correction by the BOTOX^® Cosmetic method; it also presents a challenge in facelift surgery. This area is most dynamic when talking, smiling, and eating. As one ages, both muscle and fat are lost from this area. Replacement of fat is now possible, but the real advance in this area has been the development of a permanent filling agent with a high safety and satisfaction profile--Gortex. In addition the lips can be supplemented with these techniques. In summary for the area involving the lips and around the mouth, BOTOX^® Cosmetic will not help this zone and is not recommended.

Frequently Asked Questions

What Should Be Expected After BOTOX^® Cosmetic Therapy?
 

BOTOX^® Cosmetic is a remarkably safe therapeutic agent for wrinkles. Complications have been minor and only transient. Bruising may occur where injected and a brief pain or headache may follow. Bruising may be greater in patients who are taking aspirin or any blood-thinning medicines. These products should be avoided if possible prior to the injection. Ice helps prevent bruising. Muscle weakness is first noted at 24 hours; it is not immediate.

How Long Does BOTOX^® Cosmetic Last?
 

After the first set of injections, re-injection after two weeks allows for an accurate localization of any resistant functioning muscles. With this method, 90% or more patients do respond to BOTOX^® Cosmetic. This leaves 10% who do not respond. Successful therapy is signed by muscle weakness that begins at 24 to 48 hours after injection with a peaking weakness at seven days. Paralysis after the initial injection lasts between four and seven months for most patients.

How Often Is Reinjection Needed?
 

Reinjection is suggested every three or four months to keep the muscles paralyzed and allow the furrows to completely smooth out. Once an area is smooth, patients are instructed to return for therapy only when they notice a return of muscle movement, which may not occur for four months to one year or even longer.

Who Should Not Use BOTOX^® Cosmetic?
 

• Although there have been no reports of birth defects with this medicine, no pregnant patients will be treated. It is also our policy not to inject BOTOX^® Cosmetic in nursing mothers.

• Patients with a history of neuromuscular disease (multiple sclerosis and myasthenia gravis) or other types of diseases involving neurotransmission should avoid this medicine.

What Are Alternatives To BOTOX^® Cosmetic?
 

Alternatives to BOTOX^® Cosmetic are filling agents including fat, Collagen, Fibril and Gortex; resurfacing procedures with lasers; and lifting operations of the forehead, temporal, neck, and midface regions. Myobloc is the newest alternative.

What Unexpected Benefits Have Come From The Use Of BOTOX^® Cosmetic?
 

Tension headaches have disappeared for some patients. These headaches occurred in patients who were recruiting forehead and brow muscles during periods of stress and tension. When these muscles were relaxed, the headaches faded.

How Exactly Does BOTOX^® Cosmetic Inactive The Muscle?
 

BOTOX^® Cosmetic inhibits the release of acetylcholine at the joining site of the nerve to the muscle so that the muscle never gets the message to contract. Remember, muscles only have the ability to contract: An opposing muscle contracts to produce movement in the opposite direction. To rejoin the nerve to the muscle the body organizes and produces new motor endplates, which re-establishes connection.

Does The Body Make Antibodies To The BOTOX^® Cosmetic Protein?
 

Yes, especially if enough toxin is injected often enough. The crucial amount is about 100 units (less than the usual cosmetic dosage) and booster injections placed within one month of the initial injections. Antibodies have been more of a problem for neurological disorders where larger amounts of BOTOX^® Cosmetic is required. When significant amounts of antibodies are formed, the therapeutic effects of BOTOX^® Cosmetic are greatly reduced.

Have There Been Any Reported Cases Of Allergic Reactions Or Hives To BOTOX^® Cosmetic?
 

There have been no reported cases of a true allergic reaction in nearly 20,000 treatments. People who are known to be allergic to Botulism toxin or albumin should avoid BOTOX^® Cosmetic.

What Happens If A Female Patient Becomes Pregnant Shortly Before Or After Treatment?
 

A number of neurological and ophthalmologic patients have delivered normal children after receiving their injections. For safety reasons no pregnant or nursing females will be treated.

How Painful Are The Injections?
 

The smallest needles are used and the medicine itself does not sting as much as the usual local anesthetic. Most patients feel it less than collagen. Pain can be minimized by the use of ice cooling the skin just prior to injections. Some patients find that two Tylenol tablets before the injections reduce the discomfort.

What Can Be Done For The Drooping Eyelid If This Occurs?
 

There are two opthalmological preparations that are helpful: The first is 10% phenylephrine drops and the second is lopidine. Transient drooping of one eyelid or both is the most significant complication and occurs in 1% to 2% of all injections. This drooping is a result of the local dissemination of the toxin in the injection site and can be minimized by accurate dosing, as well as proper placement, and keeping the patient in an upright position for three to four hours after injection. If drooping eyelids occur, it is usually minimal and is usually resolved within two weeks.

As A Patient, After Receiving My Injections How Can I Help BOTOX^® Cosmetic Be More Effective And Avoid Side Effects?
 

First, do not massage the area of the injection. Second, do not lie down for a nap; keep upright. Third, use the muscle; intentionally making the muscle contract helps localize the protein to the selected muscle for ablation.

When Injecting Muscles At One Site Will This Effect Remote Muscles?
 

BOTOX^® Cosmetic spreads along muscle fibers and does not spread to distant areas by way of the blood stream.

Can BOTOX^® Cosmetic Be Used To Weaken Not Totally Paralyze A Muscle?
 

Yes, in fact this is done so that the face will not be left expressionless. It can also be used to balance a weak muscle on the opposite side. By injecting medicine into the subcutaneous tissue not the muscle, and by using a smaller dosage, a weakening of the muscles is more likely occur.

For The Deepest Frown Furrows What Is The Recommended Method To Get These Deep Lines To Disappear?
 

In one study paralysis after the initial injection lasted 4-7 months. Re-injection every 3-4 months is recommended rather than waiting for the muscle to recover. This keeps the muscle paralyzed. It takes approximately 12 months for the skin to completely smooth out. It is usually 4-12 months before a return of muscle movement occurs and additional treatments are necessary.

What Accounts For The Fact That No Treatments May Be Necessary In Some Patients After Repeated Injection Sessions?
 

What happens is that the patient is broken of the bad frowning habits and may not relearn them for some time in the future.

BOTOX^® is a registered trademark of Allergan, Inc.